A competency-based preceptor programme for nursing practice : accessing contextual embedded knowledge and skills
This collaborative action research study addressed the perceived practical skill deficits in
newly qualified nurses during role transition into practice. It extended over three cycles.
Participants were newly qualified and experienced staff nurses in an acute NHS Hospital.
A qualitative exploratory study during the first cycle found that much of what beginning
staff nurses needed to know was embedded in routinised contextual activity and was not
readily accessible to them. Managing and co-ordinating the work in the complexity of the
clinical context is a composite skill, and a major component of clinical nursing practice.
Because it is quickly internalised, it is constantly unrecognised and undervalued.
A key issue was to access this knowledge and make it available to newly qualified nurses.
A Critical Pathway was developed to provide the structure and preceptor support for the
learning experience. This is a means of explicating and conceptualising the staff nurse role
and provides an overview of components whilst suggesting a time and action framework to
be progressively developed in goal directed activities. It was incorporated into a
Competency-Based Preceptor Programme along with learning contracts for specific
practical skills; both were designed to be adapted to the context-specific needs of each
clinical area. This interactive tool was tested for adaptability and effectiveness in
intervention studies in the second and third action research cycles. Qualitative and
quantitative methods were used. The data confirmed its adaptability and the positive
impact on preceptee competence and performance.
Literature from across disciplines supported and illuminated interpretation of the study
data with evidence of the infinitely complex nature and contextual dependence of practical
knowledge and skills; some of which is explicit but some is submerged in the tacit
dimensions of personal knowledge and performance. Practical thinking and action
incorporate cognitive, perceptual and embodied characteristics and features of the task
environment and are dependent on acquisition and exploitation of context-specific
knowledge. The embodied and perceptual nature of nursing skills is integral to clinical
nursing practice; and the evidence is that this embodied intelligence can only be
demonstrated and learned in contextual activity mediated by an experienced colleague.
This awareness has the potential to inform practical education and support the rationale for
a more rigorous approach to practice-based education and experience.